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DRUGGED INTO SUBMISSION [ DAY 1 OF 2 ] Forced medication straitjackets kids
State: Shots needed in emergencies Critics: Children put at
ENCARNACION PYLE
They are sent away for help. ? But when they act out, some troubled
children are controlled with potentially dangerous mind-numbing
drugs. ? No one knows how often residential centers for hard-to-
control kids use psychiatric drugs to subdue them. Privacy laws
shroud the centers in secrecy. ? But a three-month investigation of
thousands of state inspection records as well as more than 80
interviews with child-welfare workers, doctors, families, lawyers and
industry officials reveal growing concerns that pills and injections,
most of them untested on youths, have become a quick fix to stifle
??At its worst, it?s like a scene from the movie One Flew Over the
Cuckoo?s Nest with Nurse Ratched chasing after kids with syringes of
psychiatric drugs," said Gayle Channing Tenenbaum, legislative
director for the Public Children Services Association of Ohio.
At best, it?s a rare problem being addressed through better training,
says the Ohio Department of Mental Health.
But an advocacy group says Mental Health is making it easier for
treatment centers to force powerful drugs on kids without reporting it.
Ohio Legal Rights Service, which is leading the charge for change,
says the opposite should be done. Mental Health needs to impose far
stricter rules to limit the use of medications and hold centers
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Both sides agree that psychiatric drugs can help kids suffering with into treatment two years
anxiety, depression or a host of other mental illnesses. The question
in these cases is whether medications are being used to treat children
Legal Rights, an independent state agency, has examined nearly 500
cases involving chemical restraints during the past five years,
? A 5-year-old boy who was so doped up that he couldn?t stop batting
the air, complaining about imaginary bugs and smacking his lips. A
? A 10-year-old boy who was chemically restrained 69 times over 80
days. Doctors prescribed up to six drugs at a time ? and never
conducted trials to determine which pills worked for what symptoms or
? A 12-year-old girl who was injected six times over nine months with
high doses of Thorazine, a powerful sedative that can knock kids out
and cause muscle spasms and twitches. She also was physically
restrained 31 times by as many as three men, despite a history of
about its use of ??drug cocktails" last summer,
??It?s scandalous that medications are used to subdue kids for
overworked and underpaid staff or as punishment for bad behavior,"
said Carolyn Knight, the group?s executive director.
Children already traumatized by abuse, neglect or mental illness can
be hurt further by being forced to take a medication, especially when
held down by adrenaline-pumped adults, said Dr. Ellen Bassuk, an
associate professor of psychiatry at Harvard Medical School who has
??The mental-health system is a mess," she said. ??Not only are
these places giving chemical restraints, but they?re prescribing risky
combinations and dosages of drugs that are as dangerous and
State officials say Ohio law prohibits chemical restraints except in
emergencies when a child or worker is in danger. Even then, they?re
supposed to be used only after lessforceful options fail.
??It?s been outlawed," said Thomas Wood, chief of licensure and
certification for the Department of Mental Health.
Critics say the state?s 52 private residential centers often skirt the law
by calling the restraints emergency medications or a PRN order ?
short for a Latin term for giving drugs as needed.
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??No one wants to call it a chemical restraint because it is too
emotionally charged a term," said Curtis Decker, executive director of
the National Association of Protection & Advocacy Systems in
Others say the practice is protected by an unspoken rule: ??Don?t
??It happens underground all the time," said Steve Eidelman,
executive director of the ARC of the United States, a national
advocacy group for the developmentally and mentally disabled, based
??It?s all about what?s easiest for the treatment providers, not what?s
In response to that concern, workers at these centers increasingly are
being taught ways to prevent power struggles instead of how to
??It can be as easy as sitting down with a kid and telling them you
hurt my feelings when you called me a name instead of tackling them
to the ground," said Bob Bowen, chief executive officer of David
Mandt and Associates, a Texas-based training company that Bowen
Injections as threats
Concerns about overmedicated kids are being heard nationwide.
A children?s psychiatric hospital in Louisville, Ky., was chastised in
2003 for giving drugs to children before they could cause problems ?
sometimes while still asleep. Kids who refused to take pills were told
In May 2000, a nonprofit group filed a class-action lawsuit on behalf of
9,000 Tennessee children in large institutions who were given
psychiatric drugs and other restraints without proper legal consent.
??There?s no reason to think that Tennessee is an aberration," said
Doug Gray, a lawyer for the New Yorkbased, nonprofit Children?s
Defenders say drugs sometimes are needed to control the
increasingly unruly, violent youths being sent to the centers.
??They bite, hit, kick and spit," said Penny Wyman, executive director
of the Ohio Association of Child Caring Agencies, which represents
residential centers. ??They curse, yell and throw furniture. They?re
angry and have a lot of issues to work out."
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Many of the children need the kind of intensive care they?d get at a
hospital, but there aren?t enough beds, Wyman said. The state closed
most of its mental institutions in the late 1980s and early ?90s but
sent little money to community health centers to help with increased
She said Ohio Legal Rights? leaders don?t understand the challenges providers face and are on a ??
witch hunt," even though treatment centers use psychiatric drugs only as a last resort.
Others say they don?t understand the fuss.
??It?s shocking that we focus so much attention on the residential treatment centers, which have fewer
than 1,000 beds," said Michael Hogan, executive director of the Ohio Department of Mental Health.
The department licenses the centers, four- to 115-bed facilities that together can house 919 children.
Thousands of kids flow through the centers in a year, and many more are closed out.
Hogan says the biggest danger facing children is depression. There were 168 youth suicides statewide
in 2002, the most-recent figures available.
??No case of abuse or neglect is good," he said. ??But it would be wrong for us to ignore the bigger
issues, especially as our money gets tighter and tighter."
Most treatment centers are doing their best, he said. They?re adding psychiatrists, reducing overall
restraint use, training staff members and trying new, positive methods for responding when kids blow
Hogan?s department thoroughly inspects the centers every two years, or when concerns arise.
The centers typically charge $100 to more than $1,000 a day. But most still have few hiring standards
and are plagued by high turnover, Knight said. Workers often are fresh out of college and are paid
The department?s assistant medical director agrees that treatmentcenter workers often are too quick
to push drugs because they want calm, obedient children.
??It?s human nature. A lot of adults think children should be seen, not heard," Dr. Patricia Goetz
said. ??It doesn?t help that we?re a culture where you can manage everything with a pill."
State intervenes
Last April, the state ??strongly recommended" that Belmont Pines Hospital, in Youngstown, stop using
emergency medications after Goetz uncovered several troubling trends.
She reviewed 11 cases in which a total of 27 shots of the powerful drugs Haldol and Thorazine were
In a letter, Goetz noted that the medications ??have effects that last far longer than required for a
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Sleepiness can persist for hours or days. And unlike the use of other restraints, such as padded
handcuffs or physical holds, there are no limits on how long kids can be drugged, said Laurel Stine,
director of federal relations for the Bazelon Center for Mental Health Law in Washington.
??It?s just another way to abuse children who have already been victimized," Stine said.
Two years earlier, the Department of Mental Health placed Belmont Pines on probation for five months
and barred the 45-bed center from admitting more children.
The agency took action after Ohio Legal Rights and several Belmont Pines employees complained that
the facility gave too many shots of Haldol, Thorazine and Vistaril, an antihistamine used for sedation.
One man reported that his son was so drugged up during visits that he couldn?t talk or walk. The boy
essentially was being treated as a ??pincushion," said Judy Jackson-Winston, a client-rights officer for
the Cuyahoga County Mental Health Board who spoke with the father.
Belmont Pines officials said they have stopped using emergency medications and had reduced their
use by 86 percent before the state warning.
??We had already made a decision that we were going to reduce, then eliminate their use," said Dr.
Phillip Maiden, the group?s medical director. ??The Ohio Department of Mental Health just made us
Although he regrets that the center was placed on probation, Chief Executive Officer George Perry
said, ??There?s no question, we?re better for it."
Multidrug cocktails
Last summer, Goetz warned about the use of ??drug cocktails" at Pomegranate Health Systems,
which runs a center in Byesville in Guernsey County and plans to open a $5 million, 60-bed facility in
She questioned why five drugs were needed for a 15-year-old with posttraumatic stress disorder and
intermittent explosive disorder, which leads to sudden outbursts of violence.
??It is very concerning that this child is on three mood stabilizers ? Depakote, Topamax and Trileptal ?
and two antipsychotic medications ? Haldol and Seroquel," Goetz wrote. ??There is no evidence that
Topamax or Trileptal decreases aggressive behavior."
Few scientific studies have explored the risks associated with using multiple psychiatric drugs.
However, experts and researchers agree that drug cocktails increase the likelihood of death or bad
side effects. Also, many behaviorial-health drugs agitate children, so workers respond by giving them
Goetz also criticized Pomegranate for using Haldol too often and in high doses, even though the drug
can cause potentially fatal side effects, including involuntary muscle contractions, low blood pressure
Pomegranate officials defend their medication practices, saying they treat the most difficult, disturbed
children, including those who are victims of violence or attempt suicide.
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On average, the kids they see have been through 20 foster, group and residential homes,
administrator Bob Hall said. Some have had as many as 33 placements.
Most have been to a different physician or psychiatrist with each move, and each doctor has
prescribed multiple drugs. Complicating matters, the children?s medical records often don?t keep pace
Pomegranate deals with the problem by creating medical and mentalhealth work-ups within 30 to 45
days of each child?s arrival, Hall said.
??We just received a 71-page package on a kid, and there wasn?t one fact about the kid?s
medications in all that paper," Hall said.
This type of slip-up proves the system is broken, said Yvette McGee Brown, a former juvenile court
judge who is now president of the Center for Child and Family Advocacy at Columbus Children?s
But it doesn?t take residential centers off the hook.
??They should get those files," she said. ??Anything less is malpractice."
While on the bench, McGee Brown frequently called the doctors of children she thought were
??I had a 10-year-old who was so doped up he was walking around like a zombie," she said. ??Sure,
he wasn?t creating any problems. But he was barely conscious."
Problems with staff members
Chelsey Kennedy, 15, of Gahanna, never will forget the effect of being given three shots of Haldol one
afternoon at Kettering Hospital Youth Services in Dayton.
??I slept for four days and was in a drug-induced fog for a week after finally waking up," she said. ??
Chelsey, who has bipolar disorder, admits being combative and mouthy at times. But she said
residential staff members often egg on patients.
For instance, the Mental Health Department reprimanded a southern Ohio center in January for
creating a ??culture of fear and intimidation." State inspectors said the children at Oak Ridge
Treatment Center, near Ironton, complained about being cursed at, called names and insulted by staff
They also reported being choked, kneed, ??slammed" and put into a ??sleeper" wrestling hold that
Wendy Kennedy, 40, said teens are ??manhandled" at Residential Treatment Centers of Ohio, a South
Side facility where her daughter has lived since early March.
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??When I went to visit Chelsey recently, one of the girls had a black eye, bloodied nose, busted lip and
she couldn?t move her shoulder ? all because of a restraint," Kennedy said. ??Using brute force is so
Residential Treatment officials denied using excessive force and said no children have been hurt. ??
Franklin County Children Services has found nothing to substantiate any abuse," Chief Executive
But in March 2003, Children Services pulled 11 teens from the center after a worker bruised a girl?s
wrist during a restraint. The state also placed Residential Treatment Centers on probation for failing to
Beasley said the center doesn?t use any emergency medication ? ??only drugs ordered by the
However, state mental-health officials cited the facility in August for using a ??medication as a restraint
Kennedy is concerned that Chelsey might be on too many and maybe even the wrong medications.
Before entering residential care a year ago, Chelsey was on two drugs. She?s now prescribed 14 ? 11
??The side effects are terrible," said Kennedy, who turned over custody of her daughter to Franklin
County Children Services in 2004 to get her mental-health help. ??She has joint pain, reflux and no
hormone levels, which have baffled doctors."
??She can be normal one minute and like a small child another," Kennedy said. ??I just don?t
understand why they give her so many drugs but no meaningful counseling. It kills me."
Gwen Malcuit, 33, of Strasburg in Tuscarawas County, understands Kennedy?s pain. Her 16-year-old
son, Nick, was misdiagnosed four times and given more than a dozen medications before doctors
One drug made him sleep 18 hours a day. Another caused him to gain 50 pounds. A third made him
??I really believe the medications impaired his learning," Malcuit said. ??He was angry, out-of-control
Today, Nick is on one medication and enjoys life as a 10 th-grader. He is doing well in school, has a
girlfriend and is looking for a part-time job.
??Look at what happens when you give a child what he really needs: appropriate services in his own
She lays part of the blame on the confusing system.
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For example, four state agencies license residential centers: the departments of Health; Job and
Family Services; Mental Health; and Mental Retardation and Developmental Disabilities. Each has
different licensing standards. The Ohio Department of Alcohol and Drug Addiction Services also
??It?s a maze that leaves families feeling left out," Malcuit said.
It doesn?t help that families often relinquish custody of their children to county child-welfare agencies
because mental-health care is so expensive. And when they do, they frequently lose the power to
make decisions about medications. They?re also afraid to challenge decisions out of fear their children
Fewer reports
Finding out how often treatment centers use drugs to restrain children has become more difficult.
In January 2004, the Department of Mental Health stopped requiring treatment centers to fill out
incident reports for restraints unless they involved abuse or neglect, or resulted in an attempted
As a result, the number of reported restraints ? both emergency medications and physical holds ?
dropped from 6,815 in 2003 to 113 last year. Reports of emergency drugs declined from 118 in 2003 to
Mental Health officials say providers now have to log the use of restraints daily. The department
regularly reviews them and compiles totals every six months.
But advocates say the centers aren?t required to note the use of emergency drugs.
Meanwhile, state developmental disability officials have toughened their reporting requirements,
causing their figures to spike from 12 reported restraints in 2001 to 542 last year.
The Department of Mental Retardation and Developmental Disabilities also considers the use of any
unapproved psychiatric drug ? whether in an emergency or not ? a chemical restraint.
??They?re well ahead of the Department of Mental Health on this issue," Knight said.
MRDD officials admit they toughened their requirements after a scathing audit by what is now the
federal Centers for Medicare & Medicaid Services in Washington.
??It?s tough asking the painful questions, but if you don?t you?ll never know if a provider is doping a
client up with a powerful psychotropic medication just for convenience," Director Kenneth Ritchey said.
Since 2000, the department has added 14 people to its investigative unit, created an online registry of
caregivers who have abused people with disabilities, and developed a Webbased reporting system for
Ohio Legal Rights would like the Department of Mental Health to be equally vigilant, particularly in
requiring treatment centers to report the use of all restraints.
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Legal Rights points to an incident at Kettering Hospital in Dayton last July in which a 14-year-old girl
was restrained ? with drugs, handcuffs, other devices and physical force. Eight staff members, a guard
and two police officers were involved in the episode, which stretched over ??eight horrendous hours,"
Details remain sketchy, but the agency?s investigation found:
? The teen became agitated and was put in a seclusion room. State officials say she was spitting and
? While in the room, she managed to pull a mattress cover off a bed and zip herself inside. Police were
called and put her into handcuffs until she calmed down. Staff members replaced the cuffs with other
restraints and kept her tied up for more than seven hours, against state rules.
? The girl was given three shots each of Haldol and Cogentin, a medication used to offset potential
side effects from the Haldol, including stiffness and tremors. The child-welfare agency responsible for
the teen had never consented to the use of Haldol.
In the end, the guard filed charges against the girl because he had thrown out his back during the
restraint, and she was discharged to another facility.
Executive Director David Drawbaugh said Kettering is now committed to a zero-tolerance policy for
State mental-health officials said the incident ??raised a lot of concerns" but was not reportable as
a ??major unusual incident" under the department?s standards.
??This is the kind of human-rights abuse that occurred in the back wards of psychiatric hospitals 25
years ago," said Laura Wissler, a parent advocate for the Mental Health Association of Summit County.
??If this isn?t reportable, what is?"
[email protected]?2011, The Columbus Dispatch, Reproduction prohibited
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